The Minorities in Clinical Psychology Training group's Third Annual Conference; Working with the marginalised: Formulating beyond the mainstream

Tuesday 5th July 2016 at BPS Offices, Tabernacle Street, London

We are extremely pleased to be hosting our third annual conference! For this event we are focusing our attention onto alternative ways to formulate clinically which may better serve needs which clinical psychology may have been complicit in silencing. Indeed, mainstream psychotherapy models are often criticised because they take little account of social and cultural forces and of their effect upon psychological functioning and relational processes. This is a significant limitation in terms of working in ways that are more 'culturally competent' and socio-politically informed. Many marginalised groups continue to see mainstream therapy and mental health services as irrelevant and there is an on-going need to deliver interventions and formulations that take better account of the lived experience of 'minorities', of the political and of the social realities of those who are disadvantaged. For our third annual conference, the 'Minorities Group' aims to encourage a dialogue on some of the above issues by concentrating on formulation. The day will aim to make more visible the power of social and historical contexts, their related traumas and, propose ways these may become integrated within formulations.

Abstracts

“I was very fortunate to have a mother who was a homemaker, seamstress, knitter, gentlewoman, a good listener, kind, bonnie, had a sense of humour, intelligent, financially astute, hardworking, organised, and who lived with a Schizophrenia diagnosis and a Depixol depot injection every 3 weeks for over 20 years until the day she died with dignity in March 1998, aged 68, before her time.
My family are in solidarity, 8 of us in 3 generations over 60 years (that I know of), having experienced psychoses and coercive drug, and shock, treatment, taking each other in and out of psychiatric hospitals because we had no other choice: my mother and father, two younger sisters, three sons and me.
I will speak about the pain of living, expressing pain through psychoses, being silenced by psychiatry for feeling pain and being forced to take the medicine if resistant. The patriarchy of psychiatry which claims to act in loco parentis, takes away agency but fails to protect or keep safe their offspring. The infantilisation of their conscripts. Patients and staff.
I don’t believe in mental illness after seeing my mother in the locked ward of our local mental hospital in 1970 when I was 17. Distressed women shut in together, including a mother who had killed her child. I came away from visiting crying myself. Meeting with male psychiatrists who said I had an old head on young shoulders. I probably told them what they wanted to hear.”

Taking off the shell: A systemic formulation of a Muslim woman’s path to recoveryDr Jeyda Ibrahim

This case study will describe a systemic therapy approach to support a Bangladeshi Muslim lady build strength and quality of life in her new context after separating from her husband. A systemic approach was employed due to the relevance of context in the process of aiding Mrs Islam both to understand her commitments in the past and to help develop her current identity with both some of her past and some new commitments. The Atomic Model was in particular significant for the core of the therapy. In total Mrs Islam had 15 sessions of systemic therapy and completed the Clinical Outcomes of Routine Evaluation-10 (CORE-10) and Mental Health Recovery Measure (MHRM) during the assessment, middle and end of therapy. Conclusions and reflections will be discussed.

The healing paradigm of African Centred Psychotherapy (also known as Black Psychology)

Why it is needed, who for and how it can help all

How knowledge of self from an African Centred worldview is important for wellness and resilience

The role of African Centred Psychotherapy in illuminating the person' spirit (e.g. life purpose, what energises the person). This is needed so there is so much wellness promoted that there is little space for thoughts, feelings and behaviours which de-energise the spirit.

Formulation from an African Centred perspective of thoughts, feelings and behaviours which do and do not promote wellness. For example, African Centred concepts such as African psyche (McInnis in preparation), Cultural Miss-orientation (Kamron and Bowen-Reid 2010), Belief Systems Analysis (Myers 1993), Double Consciousness (Du Bois 1903), and Maat (Karenga 2006).

Intersectionality ('It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences'. 'There is no such things as a single issue struggle as we do not lead single issue lives'. Audre Lorde)

Case examples of African Centred formulation

Conclusions and ways to take things forward

Formulation across cultures - can there be such a thing?Dr Lucy Johnstone

The DCP 'Good Practice Guidelines on Psychological Formulation'
require formulations to be culturally sensitive, and specify the inclusion of social adversities and social contexts as causal factors.
The Guidelines also note that the concept of formulation itself is culturally-based. But is this enough? Lucy Johnstone will reflect on the work needed to develop appropriate forms of formulation that take these principles on board, as well as discussing the more general limitations of current conceptualisations of mental health and distress in relation to 'minority' groups.

The cycle of oppression: a framework for more socially and culturally informed formulations?Guilaine Kinouani

The 'cycle of oppression' is a psycho-socio-cultural formulation framework developed by Guilaine Kinouani to make sense of the lived experiences of members of oppressed groups. The model sets out to render visible the various manifestations of oppression in order to help formulate their impact structurally, socially and psychologically and, to help support and empower people who continue to be othered, marginalised and oppressed within society. In her presentation, Guilaine will present the model and reflect on some of the reasons which have led her to develop it. The presentation aims to be interactive and, the audience will be invited to share their reflections on working with oppression. Space will be made as part of the discussion to propose ways the model may be further developed or adapted for clinical use.

Hilary will be presenting her work on holistic CBT. This approach to CBT places a person’s individual true self central to the psychological formulation and incorporates spirituality and the social, cultural and environmental context. The formulation focuses more on a person’s strengths compared to the traditional, problem-focused CBT formulation. It also puts more emphasis on the wider context and recognises that distress is not just due to internal factors such as our thoughts but that distress is also a result of wider contextual issues. A symbol of a tree is used to represent the person’s true self or spirit and as part of the therapy process the participant gradually labels different aspects of themselves using the tree image. This creates a visual representation of who they are as part of the formulation. Hilary has used this holistic CBT approach to create a personal development course called ‘Free to be Me’ which has been run in both NHS and faith group settings.

People tend to see gender dysphoria and other issues arising from gender identity as being wrapped up exclusively in personal identity and even now, although due for revision, the ICD 10 classifies divergence from a binary gender identity congruent with physical sex as mental illness. However, as we move away from a mental health model of gender identity it becomes apparent that problems around depression, anxiety and more complex personality disorder presentations are in fact very likely to be reflective of the stresses and strains experienced by people who experience their gender beyond socially constructed norms – and who thus find it difficult to live up to societal expectations placed upon them. This change of emphasis alters the nature of the problems surrounding gender diversity and thus the formulation of a person’s issues can become less about how they need to change themselves to fit in with societal expectations and more about how they can cast off guilt and shame and learn self-compassion. Furthermore, it informs us that the problem lies as much with society as it does with the individual. So, if we want to work more effectively with people who have diverse gender identities then we have to address, at least on some level, the people around them and the society they live in. In this presentation I discuss my emerging view of the individual and societal factors which comprise the formulation around gender diverse individuals and the challenges faced in addressing them.

Speakers and Facilitators

Chrys Muirhead

SpeakerChrys Muirhead is a 63yr old writer, activist and campaigner in mental health matters who lives in Fife, Scotland; a mother of 3 sons and grandmother of 3 who identifies as a psychiatric survivor. She made a full recovery from psychoses and coercive inpatient drug treatment on 3 separate occasions, following painful, induced childbirths in 1978 and 1984, and at the menopause in 2002, doing it herself, tapering the drugs against the advice of psychiatry and getting back on with her life.

Chrys has also been an unwaged carer of many close family members who have experienced psychoses and psychiatric treatment, most recently her youngest son, aged 31, who was locked in a seclusion room of an intensive psychiatric care unit in February 2012, no toilet or water to drink, light switch outside, for hours at a time unobserved, with a broken hand untreated. After 30 months whistleblowing and campaigning this resulted in a successful Ombudsman complaint decision and an apology from NHS Fife in October 2014. Chrys is a prolific blogger and social networker, was one of the first “foreign correspondents” to be published on Mad in America in January 2012, having invited Robert Whitaker to Scotland, and Fife, to speak. She retired from writing on MIA in September 2015 to concentrate more on influencing Scottish mental health system/service transformation. Qualifications include postgrad awards in Community Education 1998 Dundee and a Teaching Qualification in Further Education 2008

Dr Jeyda Ibrahim

SpeakerDr Jeyda Ibrahim is currently a practising Clinical Psychologist in the Attachment and Trauma team in Great Ormond Street Hospital and on a National and Specialist Inpatient Adolescent ward within South London and Maudsley NHS Foundation Trust (SLAM). She is particularly interested in working with children adolescents who have experienced multiple trauma. She is also passionate about including culture and diversity as parts of her formulation and intervention in her work.

Jeyda uses a diverse range of evidence-base therapeutic approaches such as CBT and systemic therapies. She is an Honorary Lecturer for the clinical training course at King’s College for ‘treatment of self-harm’ and ‘race and culture’. She has been recently nominated to be the Freedom to Speak Up Ambassador for CAMHS services within SLAM.
Finally, Jeyda is also co-researcher for a project running across Amsterdam and London looking at why Turkish speaking immigrants are at increased risk of suicidal ideation. As part of a community intervention based on results from this project, Jeyda will be setting up an Art project to communicate the results and raise awareness to the public. Jeyda has been the Race and Culture Organiser for the Minorities group for the past three years, but this post will be coming to an end now due to Jeyda recently qualifying.

Dr Erica McInnis

Erica specialises in African Centred approaches (Black Psychology) to improving emotional well-being across both the age and ability range.
She has a specialist interest in Disability Psychotherapy and Positive Behavioural Approaches for improving the emotional and behavioural wellbeing of adults with learning disabilities (Intellectual Disabilities). She also gained a Winston Churchill Fellowship in 2016.

She has publications in the following journals such as Clinical Psychology Forum; Journal of Black Psychology; Journal of Critical Psychology, Counselling and Psychotherapy; British Journal of Learning Disabilities; Advances in Mental Health and Intellectual Disabilities; Mindfulness; British Journal of Forensic Practice; and Black Theology in Britain.

Erica was an occasional lecturer for the University of Manchester Doctorate in Clinical Psychology programme and presented at the at the 10th European Congress of Mental Health in Intellectual Disability (Florence, Italy, 2015) and 47th annual International Association of Black Psychologists conference (Las Vegas, 2015). Her spirit was illuminated by African Centred Psychology in 2010, and her soul has never looked back! Erica is black British of Jamaican parentage & committed to the journey of African spiritedness and self-development.

Dr Lucy Johnstone

SpeakerDr Lucy Johnstone is a consultant clinical psychologist,author of 'Users and abusers of psychiatry' (2nd edition Routledge 2000) and co-editor of 'Formulation in psychology and psychotherapy: making sense of people's problems' (Routledge, 2nd edition due in August 2013)and ‘A straight-talking guide to psychiatric diagnosis’ (PCCS Books 2014), along with many other chapters and articles taking a critical perspective on mental health theory and practice. She is the former Programme Director of the Bristol Clinical Psychology Doctorate and offers training to teams and services across the country. Her particular interest is in the use of psychological formulation as a means of developing personalised, evidence-based care plans and promoting team cohesion and empathy, and she was the lead author of the 'Good practice guidelines on the use of psychological formulation' (Division of Clinical Psychology 2011.) She has worked in Adult Mental Health settings for many years, most recently in a service in South Wales. She is an experienced conference speaker, lecturer and trainer.

Guilaine Kinouani

SpeakerGuilaine Kinouani is an aspiring intersectional feminist and equality enthusiast currently working toward a Doctorate in Clinical Psychology. Before this, she completed a degree in Cultural Studies and studied Counseling Psychology after obtaining a Masters in Transcultural Mental Health. Professionally, Guilaine has worked with some of the most marginalized and disenfranchised groups in various roles, and as a result she is particularly interested in liberatory, community psychology and more socially informed approaches to clinical practice.

With much support, Guilaine founded the ‘Minorities Group’, which she currently co-chairs. She writes for various media platforms/outlets as well as for www.racereflections.co.uk a site she created to provide an online space and some material to encourage reflections and conversations on various experiences of marginalisation, 'difference' and 'otherness' from a psychological and mental health perspective.

Guilaine is currently leading the development of the first ever Blackness Centered Compassion Therapy model soon to be piloted in the UK and abroad. To find out more please get in touch with her via Twitter @Kguilaine

Dr Hilary Garraway

SpeakerDr Hilary Garraway is a clinical psychologist in an Early Intervention in Psychosis team in Enfield (North London) as well as having a private practice. Hilary has trained as an adult education teacher and is a BABCP accredited CBT therapist, trainer and supervisor. Hilary began her therapeutic work as a Samaritans volunteer and then trained as a person-centred counsellor and worked with a Christian voluntary organisation providing counselling training both in the UK and in Uganda. She helped to establish and then manage a community project in East London working alongside people with long-term needs providing therapy, life skills training and practical support in what would now be called a recover college. She has an interest in using creative writing and art within therapy and she has trained in person-centred art therapy and in creative and therapeutic writing. Hilary is the Spirituality lead for the British Psychological Society and represents psychology on the National Spirituality and Mental Health Forum. Hilary is married to Hosten, who is from Grenada and they have two teenage children. Hilary has published research on holistic CBT and also on the role of mentoring to improve engagement with mental health services for Afro-Caribbean boys.

Debbie Wood

SpeakerDebbie Wood is chair of LGBT Charity; OutREACH Cumbria, a trans woman, psychotherapist and Clinical Studies Assistant Psychologist with Cumbria Partnership NHS-FT. Debbie has worked with LGB & T clients in several roles since 2011 and is currently working to develop a fledging therapy/support service for people with diverse gender identities in Cumbria. As part of this she is working with University of Cumbria on a research project into the needs of people with gender identity related issues living in rural areas. She is also currently conducting research into engagement with reflective practice training for CBT practitioners, has worked delivering CBT in an NHS drug and alcohol service and was Chair of Carlisle Samaritans from 2010-2013.